Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.
Center of Obstetrics and Gynecology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania.
Medicina (Kaunas). 2021 Nov 5;57(11):1207. doi: 10.3390/medicina57111207.
Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.
异位妊娠是一种罕见的、难以诊断的、危及生命的病理，需要由经验丰富的多学科团队及时做出决策。在这种类型的多胎妊娠中，既有宫内妊娠，也有异位妊娠。它的发病率在辅助生殖技术妊娠或排卵诱导妊娠中增加。本文介绍了一位 34 岁多产妇的角状异位妊娠病例。患者因左侧腹痛就诊，怀疑为异位妊娠，于妊娠第 14 周入院。进行了经腹超声和磁共振成像（MRI）检查，以确认左侧子宫角异位妊娠的诊断。多学科团队决定通过超声监测两种妊娠的生长情况，同时母体生命体征稳定。由于腹痛加剧，进行了诊断性腹腔镜检查。未观察到子宫破裂的迹象，也未进行其他手术。密切监测母体状况和超声检查结果。左侧子宫角的肿块没有明显变化，宫内妊娠的胎儿生长在整个妊娠期间与胎龄相符。在第 41 周妊娠时，通过自然阴道分娩产下了一名健康的女婴。由于辅助生殖技术和排卵诱导后妊娠数量的增加，异位妊娠的发生率呈上升趋势。评估风险因素非常重要。诊断异位妊娠的主要方法是超声检查和 MRI。异位妊娠的主要管理策略包括期待治疗以及异位妊娠的手术或药物终止。只有在符合特定标准的少数情况下，才可选择期待治疗作为一种选择。在适用的情况下，期待治疗可能会减少不必要的干预的频率，并有助于预防患者出现并发症。
